title: [An investigation of the relationship of inflammatory response and insulin and its components during stress hyperglycemia in critically ill patients].
abstract: OBJECTIVE
  To observe the relationship between inflammatory response and the constituents of islet β cell secretion during stress hyperglycemia (SHG) in critically ill patients, in order to study the impact of inflammatory response on insulin resistance and the secretion function of islet β cells.
  
  
  METHODS
  According to the state of inflammatory response, 45 critical patients with SHG were divided into two groups: stress and the convalescence period. Twenty five healthy individuals were enrolled as control group. The blood levels of tumour necrosis factor β (TNF-β), blood glucose (BG), and insulin components including proinsulin (PI), immunoreactive insulin (IRI), true insulin (TI), C-peptide (C-P) were measured respectively. The levels of BG, TNF-β, insulin components, insulin resistance index (HOMA-IR) and the secretion index (HOMA-β) were compared among groups. The relationship between TNF-β and BG, insulin components, HOMA-IR, HOMA-β were analyzed.
  
  
  RESULTS
  (1)There was no difference in concentrations of TI among stress period, convalescence stage and control group [3.68 (1.57, 7.70), 3.42 (2.41, 7.40), 1.46 (0.35, 4.90) mU/L, all P >0.05], whereas the concentration of BG [(10.04 ± 2.43) mmol/L], TNF-β [13.70 (11.77, 20.00) ng/L], PI [6.20 (3.22, 9.27) pmol/L], IRI [13.45 (9.88, 19.88) mU/L] and C-P [3.01 (2.37, 4.00) μg/L]in stress period were significantly higher than those in the convalescence stage[BG: (6.09 ± 0.84) mmol/L, TNF-β: 11.58 (8.80, 13.22) ng/L,PI: 1.54 (0.36, 11.82) pmol/L, IRI: 10.80 (5.35, 12.60) mU/L, C-P: 2.42 (1.17, 3.56) μg/L] and control group [BG: (4.87 ± 0.56) mmol/L,TNF-β: 9.27 (7.48, 12.16) ng/L, PI: 2.20 (1.88, 4.54) pmol/L, IRI: 5.50 (4.00, 8.00) mU/L, C-P: 1.15 (0.87, 1.76) μg/L, P <0.05 or P <0.01]. (2)The HOMA-IR [5.17 (3.41, 11.51)] in stress period was significantly higher than that in the convalescence[3.24 (1.51, 6.95)] and control group [1.14 (0.81, 1.79), P <0.05 and P<0.01]. The HOMA-β [10.80 (3.72, 31.40)] of isletβ cell in stress period was significantly lower than that in the convalescence [28.42 (6.46, 125.01)] and control group [21.94 (7.77, 62.01), P <0.01 and P <0.05]. (3)There were positive correlations between the concentration of TNF-β and PI, IRI, C-P and HOMA-IR ( r 1=0.292, r 2=0.344, r 3=0.397, r 4=0.324, P <0.05 or P <0.01). There were negative correlation between concentration of TNF-β and HOMA-β ( r =-0.235 , P <0.05) .
  
  
  CONCLUSIONS
  The severer the inflammatory response, the higher PI, IRI and C-P, while the secretion of TI is relatively deficient.Inflammatory response could affect insulin resistance and the secretion function of islet βcell during SHG in critically ill patients.
authors.affiliation: Ningxia Medical University,Yinchuan 750004, Ningxia, China.
authors.forename: Chun-xia
authors.initials: CX
authors.lastname: Ma
authors.forename: Xiang-yuan
authors.initials: XY
authors.lastname: Cao
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000378:metabolism; D016022:Case-Control Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000378:metabolism*; D007249:Inflammation; D007328:Insulin / Q000378:metabolism*; D007333:Insulin Resistance; D007515:Islets of Langerhans / Q000378:metabolism*; D008233:Lymphotoxin-alpha / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D008233:Lymphotoxin-alpha